HCPCS M1062: Patient Immunocompromised - OpenPayer

Summary & Overview

HCPCS M1062: Patient Immunocompromised

HCPCS Level II code M1062 designates a patient as immunocompromised. Nationally, clear identification of immunocompromised status is critical for care coordination, infection prevention, vaccine planning, and coverage determinations for services that are contingent on immune status. This code supports clinical documentation and billing workflows by flagging patients whose immune function affects treatment choices and resource needs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for M1062, common settings where the code is applied, and the types of administrative uses payers and providers typically associate with immunocompromised status. The publication summarizes benchmarking and policy considerations relevant to national payer programs and highlights how consistent documentation of immunocompromised status can impact coverage decisions and care pathways.

The report does not provide clinical guidance. It focuses on coding definition, expected sites of service, payer relevance, and areas where documentation and billing practices intersect with national policy and benefit design.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1062HCPCS Level IIimmunocompromisedinfection preventioncare coordinationdocumentationbillingclinical assessment

Billing Code Overview

HCPCS Level II code M1062 indicates Patient immunocompromised. This code is used to identify patients who have a compromised immune system due to medical conditions or treatments.

Service type: Clinical assessment and care related to immunocompromised status, including documentation of immunosuppression for care planning, infection control, and treatment considerations.
Typical site of service: Hospital inpatient, outpatient clinics, specialty practices (such as oncology, transplant, and infectious disease), and other clinical settings where immunocompromised status is relevant to patient management.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with documented immunocompromise presenting for counseling, vaccination, prophylactic medication administration, or routine care planning that requires coding of immunocompromised status. Example scenario: a 58-year-old patient with a history of kidney transplant maintained on chronic immunosuppressive therapy attends an outpatient infectious disease clinic visit for assessment prior to seasonal vaccination and review of opportunistic infection prophylaxis. The clinical workflow includes history and medication reconciliation, verification of transplant and immunosuppressive regimen, focused physical exam, counseling about infection risks and vaccine effectiveness, and administration of indicated vaccines or prescriptions. Documentation includes the reason for visit, explicit statement of immunocompromised status, relevant ICD-10 diagnosis codes, any procedures performed (e.g., vaccination), and application of the M1062 HCPCS Level II code to indicate patient immunocompromised status when reporting services that require or permit that modifier or condition code.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work is substantially greater than typically required for the service due to complexity related to immunocompromise.

HCPCS Level II M1013: Discharge/Discontinuation of Episode of Care

HCPCS-M1012-DISCHARGE-EPISODE-OF-CARE-DOCUMENTATION

HCPCS Level II M1012: Discharge/Discontinuation of Episode of Care

HCPCS-M1019-ADOLESCENT-DEPRESSION-REMISSION-12-MONTH-PHQ9

HCPCS M1019: Adolescent Depression Remission at 12 Months

HCPCS-M1007-OUTPATIENT-RA-ASSESSMENT-OVER-50-PERCENT-ENCOUNTERS

HCPCS M1007: Outpatient Rheumatoid Arthritis Encounter Assessment >=50%

HCPCS-M1034-180-DAYS-OPIOID-USE-DISORDER-PHARMACOTHERAPY-CONTINUITY

HCPCS M1034: 180-Day Continuous Pharmacotherapy for Opioid Use Disorder

HCPCS-M1054-URGENT-CARE-ONLY-VISITS

HCPCS M1054: Urgent Care–Only Visits

HCPCS-M1038-LUMBAR-SPINE-FRACTURE-PROCEDURE-CONTEXT

HCPCS M1038: Lumbar Spine Region Fracture at Time of Procedure

HCPCS-M1014-DISCHARGE-EPISODE-OF-CARE-DOCUMENTATION

HCPCS M1014: Discharge/Discontinuation of Episode of Care

HCPCS-M1032-ADULT-PHARMACOTHERAPY-OUD-MANAGEMENT

HCPCS M1032: Adult Pharmacotherapy for OUD

HCPCS-M1010-DISCHARGE-EPISODE-OF-CARE-DOCUMENTED

HCPCS Level II M1010: Discharge of Episode of Care Documented

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Taxonomy Code	Specialty	Notes
`2080P0217X`	Transplant Surgery	Manages organ transplant recipients who are commonly immunocompromised.
`207L00000X`	Infectious Disease	Evaluates infection risk, vaccination, and prophylaxis in immunocompromised patients.
`207R00000X`	Hematology & Oncology	Manages chemotherapy-associated immunosuppression and related preventive care.
`363A00000X`	Allergy & Immunology	Assesses primary or secondary immunodeficiency and vaccine considerations.
`2085P0800X`	Nephrology	Manages immunosuppression in renal transplant and dialysis patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D89.9`	Disorder involving the immune mechanism, unspecified	General code for immune system disorders that may underlie immunocompromised status and affect care planning.
`B20`	Human immunodeficiency virus [HIV] disease	HIV infection is a common cause of acquired immunodeficiency impacting vaccination and infection prophylaxis.
`T86.10`	Unspecified complication of kidney transplant	Post-transplant complications often coincide with chronic immunosuppression requiring special management.
`D61.9`	Aplastic anemia, unspecified	Hematologic conditions causing immunosuppression, influencing susceptibility to infection.
`C80.1`	Malignant (primary) neoplasm, unspecified site with metastasis	Advanced malignancy often leads to immunocompromise from disease or therapy, altering preventive care.
`Z94.0`	Kidney transplant status	Indicates transplant recipient status and chronic immunosuppression relevant to service coding.
`Z79.899`	Other long term (current) drug therapy	Used to indicate ongoing immunosuppressive drug therapy when relevant to clinical management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (single vaccine)	Often performed at the same visit when documenting immunocompromised status to justify vaccine selection or timing.
`99213`	Office or other outpatient visit, established patient, low to moderate severity	Common E/M code for evaluation and management of an immunocompromised patient during counseling or medication management.
`96372`	Therapeutic, prophylactic, or diagnostic injection (single)	Used when administration of prophylactic injections (e.g., immunoglobulin, biologic agents) occurs in the same encounter.
`99339`	Domiciliary or rest home visit for established patient, complex	Used when providing in-home care and coordination for an immunocompromised patient with high complexity.
`86580`	Skin test, tuberculosis; intradermal test with interpretation	May be used when assessing TB status prior to immunosuppressive therapy in immunocompromised patients.
`90460`	Immunization administration through 18 years of age, first vaccine (list separately in some payers)	If pediatric immunocompromised patients are seen, this code is used for vaccine administration and counseling.

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